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Trends That Matter for CAR-T Therapies

Posted by Leslie Small on Oct 22, 2020

This summer, a drug called Tecartus (brexucabtagene autoleucel) became the third chimeric antigen receptor T-cell (CAR-T) therapy approved by the FDA. CAR-T therapies, which use a patient's genetically modified immune cells to target and fight cancer cells, are a cutting-edge type of treatment that comes with eye-popping price tags, ranging from $373,000 to $475,000. However, a new report from OptumRx highlights an "industry trend to watch" that could eventually provide some relief to payers worried about how to finance CAR-T treatments, AIS Health reported.

Currently, CAR-T therapies' high cost is at least in part attributable to the "labor-intensive and time-consuming" manufacturing process for such drugs, stated the UnitedHealth Group-owned PBM's Drug Pipeline Insights Report for the third quarter of 2020. Essentially, T-cells are taken from a patient, treated and multiplied in a lab, and reinfused into the same patient — a completely personalized process known as autologous therapy.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Average MA Star Ratings Fall Due to Increased Weights, Cut Points

Posted by Lauren Flynn Kelly on Oct 20, 2020

Although more than three-quarters of Medicare Advantage beneficiaries remain in highly rated plans, roughly 77% of MA Prescription Drug (MA-PD) members are currently in contracts that will have 4 or more stars in 2021, down from about 81% in 2020, estimated CMS.

Approximately 49% of MA-PD plans (194 contracts) that will be offered in 2021 earned overall star ratings of 4 or higher, compared with 52% of MA-PDs (210 contracts) offered in 2020, according to CMS.

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Topics: Industry Trends, Data & Analytics, Payer

Perspectives on Provider Consolidation

Posted by Peter Johnson on Oct 15, 2020

The climate for payer mergers and acquisitions (M&A) has cooled substantially at a national level ever since the collapse of the proposed deals between Anthem, Inc. and Cigna Corp. and between Aetna Inc. and Humana Inc. However, consolidation in the provider sector has increased since the start of the COVID-19 pandemic as such firms grapple with the rapid collapse of fee-for-service revenue, AIS Health reported.

The breakdown of Anthem's bid to acquire Cigna resulted in a public spat and dueling lawsuits over Cigna’s attempt to exit their agreement before exhausting the firms' option to appeal a federal ruling against the transaction. On Aug. 31, the Delaware Court of Chancery ruled that neither firm had to pay damages to the other over the failed deal.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Trump's $200 Medicare Drug Card Proposal Prompts Criticism

Posted by Peter Johnson on Oct 15, 2020

Experts say a last-minute proposal by President Donald Trump to distribute $200 prescription drug credits to Medicare Part D enrollees on preloaded debit cards faces many unanswered questions and will be difficult to implement, especially in the short time before the Nov. 3 election, AIS Health reported.

Little is known about the drug credit plan other than what can be gleaned from public statements by the president and an unnamed HHS source cited by the Washington Post. The president announced the plan during a Sept. 24 campaign speech in North Carolina.

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Topics: Industry Trends, Provider, Payer

Radar On Market Access: CVS, OptumRx Exclude Brand-Name Inhalers From 2021 Formularies, Switch Up Diabetes Supplies

Posted by Jane Anderson on Oct 13, 2020

CVS Health Corp.'s Caremark will exclude 57 medications from its 2021 formulary and add six back. Meanwhile, UnitedHealth Group’s OptumRx subsidiary will exclude 19 medications and products while adding back five and implementing restrictions on others, AIS Health reported.

Still, only a handful of products excluded by either PBM are likely to impact many members adversely, says Marc Guieb, a pharmacist and consultant with Milliman Inc. That also applies to the exclusions announced earlier by Cigna Corp.-owned PBM Express Scripts, he adds.

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Topics: Industry Trends, Market Access, Data & Analytics, Payer

Trends That Matter on Trump Administration's Rebate Order

Posted by Peter Johnson on Oct 8, 2020

A promised executive order that would tie drug prices to their costs in other countries has yet to emerge, although President Donald Trump has promoted the order as part of his re-election campaign. Meanwhile, payers and PBMs are continuing to push back against three executive orders the Trump administration issued in July with the intention of lowering drug prices, one of which would overhaul the Medicare Part D prescription drug rebate system, AIS Health reported.

"I think the purpose of these executive orders is to give the president some talking points going into the debates," says Avalere Health founder Dan Mendelson. He adds that, regardless of their purpose, the orders will not make a difference in the real world any time soon.
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Topics: Industry Trends, Market Access, Data & Analytics

Radar On Market Access: COVID-19 Pandemic May Lower Health Care Costs, But Deferral Impact Exists

Posted by Peter Johnson on Oct 8, 2020

Health insurers will probably have lower health care expenditures in 2020 and 2021 than before the COVID-19 pandemic, according to a new analysis from Willis Towers Watson. However, the white paper emphasizes that substantial risk is still possible and says plan sponsors need to take proactive steps to blunt the future impact of deferred care, AIS Health reported.

The policy environment could change suddenly and dramatically depending on the outcome of California v. Texas, a suit that could lead the Supreme Court to overturn the Affordable Care Act, and the presidential election.

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Topics: Industry Trends, Payer

Radar On Market Access: If Preexisting Condition Protections Vanish, Health Insurers Probably Won't Cheer

Posted by Leslie Small on Oct 6, 2020

Since at least the 2017 saga when Republicans tried to repeal and replace the Affordable Care Act (ACA), one of the law’s most visible — and politically charged — components has become its protections for people with preexisting conditions. Now, with the makeup of the Supreme Court slated to shift, some experts believe those same provisions are the most at risk from being struck down alongside the law's now-defunct individual mandate, AIS Health reported.

But that begs the question: Would health insurers actually want to go back to a pre-ACA world?

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Topics: Industry Trends, Payer

Perspectives on Amazon-Sharp HealthCare Deal

Posted by Peter Johnson on Oct 1, 2020

Health care industry insiders say that Amazon.com Inc.'s Aug. 27 deal to provide Halo fitness trackers to Sharp HealthCare indicates the retail and tech giant will make big bets on clinical and actuarial data analytics, AIS Health reported.

Sharp Chief Information and Innovation Officer Michael Reagin says that Amazon will provide the San Diego-based integrated plan and provider with about 500 of the wearable fitness trackers.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Experts Remain Skeptical That SCOTUS Will Scuttle Entire ACA

Posted by Leslie Small on Sep 29, 2020

The Sept. 18 death of Justice Ruth Bader Ginsburg — which could tip the scales in favor of striking down the Affordable Care Act (ACA) — was hardly welcome news for health insurers during a year when a pandemic and a presidential election are already fueling high levels of uncertainty. However, industry analysts and legal experts say there are plenty of reasons not to hit the panic button just yet, AIS Health reported.

"This definitely increases the chance of the Supreme Court striking down the full ACA. But we're going from a pretty low likelihood base," says Chris Sloan at Avalere Health. "The odds are still really stacked against anything materially changing for the ACA."

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Topics: Industry Trends, Payer